Good afternoon, Mr. Chairman, ladies and gentlemen. I want to thank you for your invitation to appear before the Committee to talk about new developments in Quebec with respect to the prevention of obesity.
I work at the Institut national de santé publique du Québec, a paragovernmental organization. I do not represent the Government of Quebec. I am someone with expertise. I will try to answer your questions with respect to our government action plan, but I also have a number of concerns that I would like to share with you as part of the Committee's study.
Almost 60% of the adult population in Quebec and 25% of young people are overweight. We are among the provinces with the lowest prevalence, but at the same time, we recognize that it is much too high. This is clearly a serious public health issue, particularly since we anticipate lower productivity and significant health costs for our society with the onset of chronic diseases caused by obesity.
I want to draw your attention to the fact that, after centuries of relative stability as regards people's weight, the phenomenal increase we are seeing has occurred over a very short span of time. That is why are calling it an “epidemic”. That suggests that this issue is more of a societal issue than it is a health-related issue. So, there is a need to look very seriously at the reasons for that increase and avoid simple, or simplistic answers.
If it is viewed only in terms of the number of calories ingested and expended by the body through the action of eating and moving, such an approach precludes a more in-depth and multidimensional analysis, which is absolutely essential if we are to make the right decisions.
Higher body weights are the result of profound transformations that have occurred in our way of life. Nothing is the same anymore. We're talking about such phenomena as urbanization, automatization, and massive sedentation as regards work, travel and recreation. We're talking about the industrialization of our food system, and our colleague's presentation earlier was very good in that regard. We're seeing large portions, increased food energy density, such as fat and sugar, profound changes in the way we communicate, omnipresent electronics, recreation that revolves around monitor time — in other words, technology, or modernity is everywhere.
And yet some of the behaviours that are a result of this social transformation — such as the fact that children no longer play outdoors, for example — can be explained by a number of significant factors that warrant consideration. Profound social changes are taking place. Let's take the example of two parents who work — which is the case for most families — and who are not really available to meet their child's needs. There are other examples as well: broken families; the fact that families have fewer children, which doesn't really allow children to prepare themselves for group play, which is what we were exposed to; the fact that children attend schools with a particular vocation in faraway neighbourhoods, meaning that they no longer attend neighbourhood schools. All of that is transforming the social fabric and people's lifestyles, and thus influencing behaviours that affect health.
So, there is a very clear consensus among experts, who are supported by the World Health Organization. I imagine that you have looked at the WHO's strategy on nutrition, physical activity and health, which points to the simplistic nature of an approach that relies on counting the calories that are ingested and expended. The weight problem is possibly the greatest challenge facing humanity. It certainly is of the same scope as global warming and other major issues.
The WHO is currently the lead organization guiding global action on obesity and lifestyles, through its strategy. I would just like to mention a number of the WHO's major policies, although I will let you read about them yourselves. Quebec has drawn extensively on those strategies in developing its own plan. So, I will be referring to them indirectly.
Many countries have developed plans with a view to preventing obesity and promoting healthy lifestyles. Two weeks ago, a symposium was held in Quebec that brought together twelve or more countries.
I will leave you a copy of the brochure that we have produced, which includes a table laying out f the various plans.
Now I would like to talk about what is being done in Quebec. Unfortunately, from World War II until the year 2000, Quebec, like many provinces and countries, was not particularly active in promoting healthy lifestyles. So, we are all aware that we have a lot of catching up to do, because we have probably missed an entire generation.
Since 2000, various initiatives in Quebec have turned out to be the precursors of the government plan launched three weeks ago by Minister Couillard. However, I would remind you that this is a government plan. I would like to list those different initiatives and leave some documentation with you, because they have been an essential source of inspiration for a vision that is broadly shared by stakeholders in Quebec and that is along the lines of what I talked about a couple of minutes ago.
First of all, there is the work carried out by the provincial task force looking at the problem of overweight, this being an expert group that has been sitting for the last five years, probably very much like this Committee, as well as a task group on healthy lifestyles which was put in place by Jean Charest following the Generations Forum. You will find a report prepared by that task group in the documents I have provided.
The Perrault Task Group was supported by interministerial working groups. This is an important point that was raised in the WHO policy. The fact is that this issue involves a number of different areas — indeed, probably all areas of civil society. Therefore, governments also need to work on an interministerial basis. Six ministries, six deputy ministers, as well as six content professionals worked closely with the Perrault Task Force as it carried out its work. The interministerial thrust was provided through the work of the Perrault Task Group. A government plan was quickly developed that relied on seven different ministries and three government organizations.
I will leave you a copy of the government action plan entitled “Investing in the Future”. We are now in the process of printing it, but I would like to talk about the main features of the plan.
First of all, it is a government plan. Although it is extremely difficult to implement a strategy that is meaningful for the ministries and sectors involved, it is absolutely essential. We have to get as many sectors involved as possible; we cannot simply implement a couple of programs, because the problem is too important and becoming too entrenched in a great many sectors.
The good news is that resources have been set aside for this. We all know what happens to government plans for which there are no resources. So, new resources are to be made available, even though some ministries have already made commitments along those lines. The Fondation Lucie et André Chagnon, which is the primary philanthropic organization in Quebec, has also taken a deep interest in this issue and is assisting the government with its public-private partnership approach.
Although it aims to reduce the very targeted phenomenon of obesity, the plan also includes a much broader vision of the causes, consequences and solutions, as I was saying earlier, by providing a broader definition of such issues as obesity and overweight, as well as all the problems associated with thinness.
At the present time, Minister Couillard is very interested in the issues raised by very thin models — not only anorexia, bulimia and eating disorders, but also people's concern with thinness. People who experience that concern find themselves in a rather paradoxical situation, in the sense that they are exposed simultaneously to both abundance and ultra thin models.
An important feature of the plan relates to the locus of responsibility. The plan places a great deal of emphasis on such concepts as the environment, as opposed to individual behaviours. I think that is extremely important. It is also fully in keeping with the WHO strategy.
The plan does identify children, but it does not focus only on them. They are not really responsible. Rather, families and other social actors who care for them are the ones to be mobilized.
There is also another very important factors the rules underlying implementation of the plan; a central authority responsible for general coordination — namely the Public Health Branch; the identification of outcomes based on shared responsibilities within Cabinet.
In Quebec, there is also some reliance on section 54 of the Public Health Act, which gives the Minister of Health some very significant levers for mobilizing other ministers within Cabinet.
In closing, I would just like to identify the five main thrusts of our intervention. I was asked very specific questions, but I can't really answer them because of the very limited time available.
The first thrust is to promote and support the development of environments that encourage health eating habits.
The second thrust is to promote and support the creation of environments that foster a physically act of lifestyle.
The third thrust is to carry out societal campaigns and encourage changes in social norms so that they support healthy lifestyles, healthy eating, a physically active life, and a variety of body images.
The fourth thrust is to intensify and improve services available to people with weight problems and to help intervenors adapt their practice to this particular issue; also, to place restrictions on the sale and use of diet products, services and other means that are increasingly available; the more we talk about obesity, the more there are of these kinds of products and services.
Finally, the fifth thrust is to foster research and knowledge transfer with respect to healthy lifestyles, based on the complexities of weight related issues.
I could perhaps provide you with more detailed information about certain programs and certain activities associated with the these policy thrusts that could be of interest to you.
Thank you very much.